Surgical Task Performance Research Articles

Using mobile EEG to study auditory work strain during simulated surgical procedures

Surgical personnel face various stressors in the workplace, including environmental sounds. Mobile electroencephalography (EEG) offers a promising approach for objectively measuring how individuals perceive sounds. Because surgical performance does not necessarily decrease with higher levels of distraction, EEG could help guide noise reduction strategies that are independent of performance measures. In this study, we utilized mobile EEG to explore how a realistic soundscape is perceived during simulated laparoscopic surgery. To examine the varying demands placed on personnel in different situations, we manipulated the cognitive demand during the surgical task, using a memory task. To assess responses to the soundscape, we calculated event-related potentials for distinct sound events and temporal response functions for the ongoing soundscape. Although participants reported varying degrees of demand under different conditions, no significant effects were observed on surgical task performance or EEG parameters. However, changes in surgical task performance and EEG parameters over time were noted, while subjective results remained consistent over time. These findings highlight the importance of using multiple measures to fully understand the complex relationship between sound processing and cognitive demand. Furthermore, in the context of combined EEG and audio recordings in real-life scenarios, a sparse representation of the soundscape has the advantage that it can be recorded in a data-protected way compared to more detailed representations. However, it is unclear whether information get lost with sparse representations. Our results indicate that sparse and detailed representations are equally effective in eliciting neural responses. Overall, this study marks a significant step towards objectively investigating sound processing in applied settings.

Evaluation of forces applied to tissues during robotic-assisted surgical tasks using a novel force feedback technology

BackgroundThe absence of force feedback (FFB) is considered a technical limitation in robotic-assisted surgery (RAS). This pre-clinical study aims to evaluate the forces applied to tissues using a novel integrated FFB technology, which allows surgeons to sense forces exerted at the instrument tips.MethodsTwenty-eight surgeons with varying experience levels employed FFB instruments to perform three robotic-assisted surgical tasks, including retraction, dissection, and suturing, on inanimate or ex-vivo models, while the instrument sensors recorded and conveyed the applied forces to the surgeon hand controllers of the robotic system. Generalized Estimating Equations (GEE) models were used to analyze the mean and maximal forces applied during each task with the FFB sensor at the “Off” setting compared to the “High” sensitivity setting for retraction and to the “Low”, “Medium”, and “High” sensitivity settings for dissection and suturing. Sub-analysis was also performed on surgeon experience levels.ResultsThe use of FFB at any of the sensitivity settings resulted in a significant reduction in both the mean and maximal forces exerted on tissue during all three robotic-assisted surgical tasks (p < 0.0001). The maximal force exerted, potentially associated with tissue damage, was decreased by 36%, 41%, and 55% with the use of FFB at the “High” sensitivity setting while performing retraction, dissection, and interrupted suturing tasks, respectively. Further, the use of FFB resulted in substantial reductions in force variance during the performance of all three types of tasks. In general, reductions in mean and maximal forces were observed among surgeons at all experience levels. The degree of force reduction depends on the sensitivity setting selected and the types of surgical tasks evaluated.ConclusionsOur findings demonstrate that the utilization of FFB technology integrated in the robotic surgical system significantly reduced the forces exerted on tissue during the performance of surgical tasks at all surgeon experience levels. The reduction in the force applied and a consistency of force application achieved with FFB use, could result in decreases in tissue trauma and blood loss, potentially leading to better clinical outcomes in patients undergoing RAS. Future studies will be important to determine the impact of FFB instruments in a live clinical environment.

Impact of Operative Room Noise on Laparoscopic Performance—A Prospective, Randomized Crossover Trial

IntroductionSurgeons are often exposed to different types of operative room (OR) noise, for instance machine alarms, phone calls, and interacting objects. The aim of this study was to evaluate the effect of OR noise on the surgeons’ laparoscopic performance. MethodsA total of 30 laparoscopic novices participated in this single-center, prospective, randomized cross-over trial after completing a standardized laparoscopic training until reaching proficiency. Afterward, all participants performed four different laparoscopic tasks (peg transfer, circle cutting, balloon resection, suture, and knot) twice, once under noise exposure (intervention group), and once without any noise (control group). Primary endpoints were the force exertion and motion analyses. To assess the psychological workload the NASA task load index score was used. ResultsThe error rates varied and were significantly different between the noise and the control group. More complex tasks like the circle cutting and suture and knot task revealed higher error rates concerning precision (circle cutting: P < 0.01; suture and knot: P < 0.01). In line with increased error rates in the circle cutting task, increased NASA task load index scores were observed in this task (P = 0.03). However, no significant differences were found in force parameters, such as the maximal force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) and the mean force exertion (peg transfer: P = 0.43; circle cutting: P = 0.54; balloon resection: P = 0.64; suture and knot: P = 0.63) between the groups. ConclusionsExposure to normal OR noise led to higher error rates in two of four tasks. This effect could be linked to an increased psychological workload that was present under normal OR noise exposure. However, normal OR noise does not appear to impact surgical novices' laparoscopic task performance regarding applied forces and instrument motion.

Effect of laparoscopic handle size on surgical performance: A randomized crossover trial

Laparoscopic instrument handles design and dimensions are crucial to determine the configuration of surgeons' hand grip and, therefore, can have a deleterious effect on overall surgical efficiency and surgeons' comfort. The aim of this study is to investigate the impact of laparoscopic handle size and hand surface area on surgical task performance. A single-blind, randomized crossover trial was carried out with 29 novice medical students. Participants performed three simulated tasks in "black box" simulators using two scissor-type handles of different sizes. Surgical performance was assessed by the number of errors and time required to complete each task. Hand anthropometric data were measured using a 3D scanner. Execution time was significantly higher when cutting and suturing tasks were performed with the smaller handle. In addition, hand surface area was positively correlated with peg transfer task time when performed with the standard handle and was correlated with cutting task time in small and standard handle groups. We also found positive correlations between execution time and the number of errors executed by larger-handed participants. Our findings indicate that laparoscopic handle size and hand area influence surgical performance, highlighting the importance of considering hand anthropometry variances in surgical instrument design.

Adaptive Human-Robotic Interaction for Robotic-assisted Surgical Settings.

Increased complexity in robotic-assisted surgical system interfaces introduces problems with human-robot collaboration that result in excessive mental workload (MWL), adversely impacting a surgeon's task performance and increasing error probability. Real-time monitoring of the operator's MWL will aid in identifying when and how interventions can be best provided to moderate MWL. In this study, an MWL-based adaptive automation system is constructed and evaluated for its effectiveness during robotic-assisted surgery. This study recruited 10 participants firstto perform surgical tasks under different cognitive workload levels. Physiological signals were obtained and employed to build a real-time system for cognitive workload monitoring. To evaluate the effectiveness of the proposed system, 15 participants were recruited to perform the surgical task with and without the proposed system. The participants' task performance and perceived workload were collected and compared. The proposed neural network model achieved an accuracy of 77.9% in cognitive workload classification. In addition, better task performance and lower perceived workload were observed when participants completed the experimental task under the task condition supplemented with adaptive aiding using the proposed system. The proposed MWL monitoring system successfully diminished the perceived workload of participants and increased their task performance under high-stress conditions via interventions by a semi-autonomous suction tool. The preliminary results from the comparative study show the potential impact of automated adaptive aiding systems in enhancing surgical task performance via cognitive workload-triggered interventions in robotic-assisted surgery.

Effects of Optical See-Through Head-Mounted Display Use for Simulated Laparoscopic Surgery

This study investigated the influence of using optical see-through head-mounted displays (OST-HMDs) as a replacement for conventional monitors for an extended duration, as required for laparoscopic surgery. We developed the experiment scenario including two displays (surgical field and patient vitals) in three different combinations of the HMD and conventional monitors. An experiment was conducted to compare the task performance, situation awareness, physical discomfort, and perceived workload in the three different display settings. From this study, it was shown that even though the OST-HMD resulted in higher physical discomfort and lower self-perceived performance rating, the surgical task performance, and situation awareness were not worse, and in some conditions even better than conventional monitors. The main obstacle to using OST-HMDs to replace conventional monitors in laparoscopic surgery would be the weight of the HMDs and the head discomfort caused by wearing them for a long time.

From QoS to QoE plus QoT in Beyond 5G Networks

In the Beyond 5G (B5G) era, a paradigm shift from technical Quality of Service (QoS) oriented networks to user-centric Quality of Experience (QoE) centred network architectures is expected to occur. With this development, the infusion of QoE user requirements into B5G networks will be critical to the emergence of ultra-reliable and ultra-low latency haptic-enabled Internet applications of the future. One such application which will signify the emergence of a tele-haptic Internet will be the mission-critical use case of remote robotic surgical task performance, precipitating a transition from content-based to skillset delivery networks for an augmented user experience. In extending network QoS to user focused QoE and with it, Quality of Task (QoT) dimensions, human users in a global control loop (such as robotic surgeons) will be capable of true-to-life immersive remote task performance through the manipulation of objects in real-time and across large geographical distances. In this paper, we discuss the linkages between network and user-centric QoS and QoE (with QoT) perspectives. Further, we explain the emergence of a future B5G network and haptic-enabled Internet of Skills (IoS), and draw on the example of an architecture applied to the task-sensitive mission-critical use case of tele-haptic surgery. In doing so, we conceptualise and present Task-Technology Fit (TTF) theoretical and predictive modelling that can be empirically applied to this futuristic use case for a novel QoE/QoT perspective of future B5G communication networks.

270 The Innate Aptitude's Effect on the Surgical Task Performance

Abstract Aim Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Method A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3-null hypothesis, and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusions Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

EP-19 The innate aptitude's effect on the surgical task performance

Abstract Aims Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance. Methods A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores. Results The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75). Conclusion Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.

The effect of checklists on the surgical performance during laparoscopic cholecystectomy: A systematic review

Laparoscopic cholecystectomy (LC) is known to be one of the most widely performed general surgical operations. However, it is associated with an increased incidence and severity of complications especially during the period of a surgeon's proficiency-gain curve. Certain complications could be prevented by decreasing the incidence and consequences of surgeon errors. We aimed to systematically review the application of checklists during LC and their effect on the surgical task performance. A systematic review was performed in compliance with the PRISMA guidelines. A search was performed on PubMed, ScienceDirect and the Cochrane-Library databases. English language articles published to November 2020 were included in this study. The terms included: ‘Checklist and laparoscopic cholecystectomy’, ‘checklist and laparoscopic surgery’, ‘checklist and cholecystectomy’ and checklist and minimally invasive surgery’’. MERSQI score was applied for quality assessment. The research protocol was registered with PROSPERO register (CRD42021209118). The systematic search resulted in 8862 citations, of which 23 relevant citations were assessed for eligibility. A final 9 articles (1079 procedures) were included. The endpoints were equipment-related-risk events, numbers and types of adverse events, rate of conversion to open cholecystectomy, team communication and coordination, the number of consequential and inconsequential errors. MERSQI mean score was 10.8 (range 5 to 13). The positive effect of checklists on the performance during LC was supported with 5 high-quality studies. The effect of the checklists application during LC showed a significant improvement of the surgical task performance by decreasing the surgeons’ errors. A combination of pre-operative safety and intra-procedural checklists can be the subject of future research for possible application during routine laparoscopic cholecystectomy.

Machine Learning based Classification of Local Robotic Surgical Skills in a Training Tasks Set.

During surgical training, it is important for the surgeon develops good motor skills throughout his training. For this reason, various surgical training systems have been developed to enhance these skills. However, one of the great challenges in these training systems is being able to objectively measure the ability and performance of the main surgical tasks, where currently only a global measurement is obtained once the task is completed. In this work, a temporal evaluation scheme is proposed, that is, an evaluation of local surgical performance at different time intervals during the training of typical tasks (knot-tying, needle-passing and suturing). The goal is to automatically classify expert (experience >100 hrs) and non-expert (experience <10 hrs) surgeons according to their performance during training, based on three classifiers: K-Nearest Neighborhood, Random Forest, and Support Vector Machine Unlike other previously reported methods, this work proposes a new evaluation scheme based on segments or time intervals, which can be an indicator of the surgeon's local performance during a robotic surgical task, without the need for direct labeling of the data at the segment level. The classification performance from obtained results was in accuracy 83% to 100%, 88% to 100% of AUC-ROC, and 88% to 100% of F1-Score in the final test between experts and non-experts surgeons, where the Support Vector Machine classifier presented the best performance. These results suggest that this proposed method by time intervals could be used in various surgical trainers to evaluate the local performance of a surgeon during trainingand thus be able to provide a tool for the quantitative visualization of opportunities to improve surgical skills.Clinical relevance- We consider that the proposed method to carry out a local performance evaluation during surgical training can provide useful information in the learning and improvement of surgical skills.

TP8.2.6 The effect of checklists on the surgical performance during laparoscopic cholecystectomy: A systematic review

Abstract Aims Laparoscopic cholecystectomy (LC) is known to be one of the most widely performed general surgical operations. However, it is still associated with an increased incidence and severity of complications especially during the period of a surgeon’s proficiency-gain curve. Certain complications could be prevented by decreasing the incidence and consequences of surgeon errors. We aimed to systematically review the use of checklists during LC and their effect on the surgical task performance. Methods A systematic review was performed in compliance with the PRISMA guidelines. A search was carried out on PubMed, ScienceDirect and the Cochrane-Library databases. English language articles published to November 2020 were included in this study. The terms included: ‘Checklist and laparoscopic cholecystectomy’, ‘checklist and laparoscopic surgery’, ‘checklist and cholecystectomy’ and checklist and minimally invasive surgery’’. MERSQI score was applied for quality assessment. The research protocol was registered with PROSPERO register (CRD42021209118). Results The results of the systematic search resulted in 8862 citations, of which 23 relevant citations were assessed for eligibility. A final 9 articles were included in this study. The endpoints were equipment-related-risk events, numbers and types of adverse events, rate of conversion to open cholecystectomy, team communication and coordination, the number of consequential and inconsequential errors. The positive effect of checklists on the performance during LC was supported with 5 high-quality studies. Conclusion The effect of checklists application during LC showed a significant improvement of the surgical task performance by decreasing the number of surgeons’ errors. We envisage the routine use of checklists during LC.

Influence of musical background on surgical skills acquisition

BackgroundThere is growing interest in identifying trainees with surgical aptitude predictive of eventual technical proficiency. Musical tasks involve complex, cerebral activity, and ambidextrousity, which may have a positive impact on the acquisition of surgical skill sets. The purpose of this study was to investigate the influence of prior musical experience on the performance of basic surgical skills. MethodsThis was a prospective cross-sectional study involving 51 novice undergraduate and medical school trainees with no prior surgical exposure. Musicality was assessed with a detailed survey and objectively with the Mini-Profile of Music Perception Skills test. Dexterity was assessed using the Purdue Pegboard test. Surgical skills were then evaluated by performing 2 timed suturing trials after observing tutorial video, followed by a timed laparoscopic peg transfer test. Outcomes included both speed and quality of performance. ResultsParticipants with prior musical experience performed better than nonmusicians on the Mini-Profile of Music Perception Skills test (P = .015), dominant hand dexterity (P = .05), suture quality (P < .03), and laparoscopic peg transfer speed (P < .01). There was no significant difference in the suturing speed between musicians and nonmusicians. The dexterity and Mini-Profile of Music Perception Skills scores were predictive of suture quality (P < .01). Among musicians, duration of musical training, inactivity, instrument type, and certification levels did not correlate with differences in surgical task performance. ConclusionMusical background is associated with better performance of fundamental surgical skills among surgical novices, particularly technique quality. Although this does not imply superior ultimate surgical ability, musicality may be a marker for basic surgical skill development useful in identifying suitable candidates for surgical training.

Effect of Emotional Response on the Performance of a Simulated Laparoscopic Task.

An emotional state impacts task performance and cognition. However, evidence of the effect of an induced emotional state on laparoscopic performance has not yet been documented. We investigated whether surgical residents in whom a positive emotion had been induced would produce a better laparoscopic task performance than residents in whom a negative emotional state had been induced. This controlled laboratory study recruited a total of 53 junior surgical residents who were divided into 3 groups. Each group was required to watch 1 of 3 ten-minute videos designed to evoke a positive, neutral, or negative emotion before performing a laparoscopic cholecystectomy on a virtual simulation model. Task performances, as evaluated by a global assessment form and psychomotor metrics that included task time, errors, and path lengths, were compared between the 3 groups. Video watching induced different emotions, as measured by a Visual Analog Scale on feelings. The task time was significantly shorter in the positive (13.7 ± 2.5 minutes) than in the neutrally (17.7 ± 3.9 minutes) and the negatively (18.5 ± 3.8 minutes) induced-emotion groups (P < 0.001).Participants in the positive emotion group completed a laparoscopic cholecystectomy with a significantly lower error rate (2 vs. 4 vs. 7, P = 0.036) and shorter right-handed path length (1089.6 ± 250.6 cm vs. 1287.2 ± 355.5 cm vs. 1410.3 ± 304.1 cm, P = 0.010) than the participants in the neutral and negative emotion groups. A positive emotion can enhance a simulated laparoscopic task performance as assessed by task time and path length. The results indicate that we might improve surgical task performance by adjusting the surgeon's emotional state. We plan a future study that will continue to investigate whether positive emotions can facilitate skill learning.

Frontal theta brain activity varies as a function of surgical experience and task error

ObjectiveInvestigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded...

Does the method of visualization impact the performance of a new surgical task in novice subjects?

Evolution of optical technology from two-dimensional to three-dimensional (3D) systems has come with an associated loss of stereoscopy and 3D depth perception. This report compares performance of surgical tasks in unbiased subjects using these systems. Untrained subjects were randomized into two groups, robotically operated video optical telescopic-microscope (ROVOT) or surgical microscope (microscope). Subjects sutured and tied knots. Completion time, NASA-Task Load Index (TLX), and galvanic skin responses were analyzed. Intergroup analysis of suture completion time indicated that microscope use was significantly faster compared to ROVOT, whether used first or second. Regardless of which methodology was used first, the second modality was faster, indicating a transfer effect. NASA-TLX indicated that mental, performance, effort, and frustration were all greater with ROVOT. Task completion time and perceived effort were greater with ROVOT. Task completion times improved with repetition regardless of visual modality.

A novel noncontact detection method of surgeon's operation for a master-slave endovascular surgery robot.

Master-slave endovascular interventional surgery (EIS) robots have brought revolutionary advantages to traditional EIS, such as avoiding X-ray radiation to the surgeon and improving surgical precision and safety. However, the master controllers of most of the current EIS robots always lead to bad human-machine interaction, because of the difference in nature between the rigid operating handle and the flexible medical catheter used in EIS. In this paper, a noncontact detection method is proposed, and a novel master controller is developed to realize real-time detection of surgeon's operation without interference to the surgeon. A medical catheter is used as the operating handle. It is enabled by using FAST corner detection algorithm and optical flow algorithm to track the corner points of the continuous markers on a designed sensing pipe. A mathematical model is established to calculate the axial and rotational motion of the sensing pipe according to the moving distance of the corner points in image coordinates. A master-slave EIS robot system is constructed by integrating the proposed master controller and a developed slave robot. Surgical task performance evaluation in an endovascular evaluator (EVE) is conducted, and the results indicate that the proposed detection method breaks through the axial measuring range limitation of the previous marker-based detection method. In addition, the rotational detection error is reduced by 92.5% compared with the previous laser-based detection method. The results also demonstrate the capability and efficiency of the proposed master controller to control the slave robot for surgical task implementation. Graphical abstract A novel master controller is developed to realize real-time noncontact detection of surgeon's operation without interference to the surgeon. The master controller is used to remotely control the slave robot to implement certain surgical tasks.

Steerable OCT catheter for real-time assistance during teleoperated endoscopic treatment of colorectal cancer.

When detected early, colorectal cancer can be treated with minimally invasive flexible endoscopy. However, since only specialized experts can delineate margins and perform endoscopic resections of lesions, patients still often undergo colon resections. To better assist in the performance of surgical tasks, a robotized flexible interventional endoscope was previously developed, having two additional side channels for surgical instrument. We propose to enhance the imaging capabilities of this device by combining it with optical coherence tomography (OCT). For this purpose, we have developed a new steerable OCT instrument with an outer diameter of 3.5 mm. The steerable instrument is terminated with a 2 cm long transparent sheath to allow three-dimensional OCT imaging using a side-focusing optical probe with two external scanning actuators. The instrument is connected to an OCT imaging system built around the OCT Axsun engine, with a 1310 nm center wavelength swept source laser and 100 kHz A-line rate. Once inserted in one of the side channels of the robotized endoscope, bending, rotation and translation of the steerable OCT instrument can be controlled by a physician using a joystick. Ex vivo and in vivo tests show that the novel, steerable and teleoperated OCT device enhances dexterity, allowing for inspection of the surgical field without the need for changing the position of the main endoscope.

Hamlyn CRM: a compact master manipulator for surgical robot remote control

PurposeCompact master manipulators have inherent advantages, since they can have practical deployment within the general surgical environments easily and bring benefits to surgical training. To assess the advantages of compact master manipulators for surgical skills training and the performance of general robot-assisted surgical tasks, Hamlyn Compact Robotic Master (Hamlyn CRM) is built up and evaluated in this paper.MethodsA compact structure for the master manipulator is proposed. A novel sensing system is designed while stable real-time motion tracking can be realized by fusing the information from multiple sensors. User studies were conducted based on a ring transfer task and a needle passing task to explore a suitable mapping strategy for the compact master manipulator to control a surgical robot remotely. The overall usability of the Hamlyn CRM is verified based on the da Vinci Research Kit (dVRK). The master manipulators of the dVRK control console are used as the referenceResultsMotion tracking experiments verified that the proposed system can track the operators’ hand motion precisely. As for the master–slave mapping strategy, user studies proved that the combination of the position relative mapping mode and the orientation absolute mapping mode is suitable for Robot-Assisted Minimally Invasive Surgery (RAMIS), while key parameters for mapping are selected.ConclusionResults indicated that the Hamlyn CRM can serve as a compact master manipulator for surgical training and has potential applications for RAMIS.

Assessing Surgical Task Load and Performance: A Comparison of Simulation and Maritime Operation.

This study examined the effects of simulated and actual vessel motion at high seas on task load and surgical performance. This project was performed in phases. Phase I was a feasibility study. Phase II utilized a motion base simulator to replicate vessel motion. Phase III was conducted aboard the U.S. Naval Ship Brunswick. After performing surgical tasks on a surgical simulation mannequin, participants completed the Surgical Task Load Index (TLX) designed to collect workload data. Simulated surgeries were evaluated by subject matter experts. TLX scores were higher in Phase III than Phase II, particularly at higher sea states. Surgical performance was not significantly different between Phase II (84%) and Phase III (89%). Simulated motions were comparable in both phases. Simulated motion was not associated with a significant difference in surgical performance or deck motion, suggesting that this simulator replicates the conditions experienced during surgery at sea on the U.S. Naval Ship Brunswick. However, Surgical TLX scores were dramatically different between the two phases, suggesting increased workload at sea, which may be the result of time at sea, the stress of travel, or other factors. Surgical performance was not affected by sea state in either phase.